Crystal Springs resident Shan Copeland suffers from pseudotumor cerebri, a condition in which pressure inside the skull increases for no obvious reason. Copeland credits Medicaid with saving her life
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The Mississippi Division of Medicaid said the removal of limits on doctor's visits and prescriptions — one of the most significant changes in the Medicaid bill during the 2018 session — will not take effect July 1.(Photo11: Rogelio V. Solis, AP)

Months after passing a Medicaid bill intended to provide better health and lower costs, lawmakers have learned the agency plans not to implement those provisions July 1.

Mississippi had been heralded for its decision to give Medicaid beneficiaries more opportunities to see their doctors and cover more prescriptions — two of the most significant provisions in the Medicaid bill passed this year.

But the legislation gave the Mississippi Division of Medicaid discretion to make the changes — and it has so far decided against it.

Some lawmakers told the Clarion Ledger they thought the bill required Medicaid to "delete the annual limit on physician visits" and "delete the monthly prescription limit for Medicaid beneficiaries."

While those two directives do appear in the bill's title, the body of the bill says the division will reimburse "physician visits as determined by the division" and that "prescription drugs and other covered drugs and services as may be determined by the division."

"What this means to me is that what the Legislature discussed on the House floor and what the members voted on is not in this bill," said Rep. Becky Currie, R-Brookhaven, a nurse who advocated for the cap removal. "This is not the conference report we agreed to."

Rep. Jarvis Dortch, D-Jackson, said he caught the error and brought it to the attention of his colleague and the House bill's author, Rep. Jason White, R-West.

Dortch said he was assured "that everyone, including the DOM, wanted to lift the caps so there was no problem with the open-ended language in the conference report."

"I voted NAY because the text in the bill granted too much authority to the DOM (Division of Medicaid). I think it is ridiculous that the authors of the legislation are now claiming they didn't know what they were passing," Dortch wrote in a Tweet.

Dortch said the confusion illustrates the need for lawmakers to hold more committee meetings and spend more time discussing legislation prior to the deadline.

The provisions, discussed at various times throughout the session, sought to remove the limit of 12 doctor visits a year and increase the number of monthly prescriptions for fee-for-service Medicaid beneficiaries.

The Legislature adopted the measures in an effort to prioritize prevention — reducing serious illnesses and emergency room visits.

The Mississippi Division of Medicaid released a notice June 8 saying the Legislature gave it the "flexibility" to remove limits on doctor's visits and prescriptions.

"DOM officials are grateful to have received these additional flexibilities from state legislators, and the agency is carefully exploring responsible reforms that will be in the best interest of Mississippi Medicaid beneficiaries and taxpayers," the notice said.

Lawmakers say it was not their intent to give Medicaid the option, but to direct them to remove the limits.

"Both houses were under the opinion that we were not giving the Division of Medicaid a choice in the matter," Currie said. "So I'd like to know what happened to the bill after it passed both chambers that now gives discretion to the division of Medicaid."

Senate Medicaid Committee Chairman Brice Wiggins, R-Pascagoula, who drafted the initial bill, said Medicaid, like any agency, is responsible for implementing the laws his colleagues pass.

"And I do understand there has to be due diligence in reviewing it," Wiggins said. "But the intent of me personally, and I believe the full Legislature, is that that was to be enacted ... What studies have shown across the county is that the cap on physician visits has not, in the end, saved money. In fact, in some cases it has led to higher costs."

In a statement to the Clarion Ledger, Medicaid Director Drew Snyder said the Legislature voted to give the division authority to determine the number of doctor's visits and monthly prescriptions it will cover.

"For me, it all starts with the law," said Snyder, who went from serving as Gov. Phil Bryant's deputy chief of staff to heading Medicaid just before the 2018 legislative session. "There is a lot of support among legislators and within the division to relax visit limits, but there is also a recognition that the Medicaid program should be operating within its appropriation. We are examining ways to responsibly implement a policy change that is affordable today and would be sustainable over time."

Virtually all health care professionals who testified in front of lawmakers, including the Medical Care Advisory Committee, partially appointed by Bryant, recommended Medicaid eliminate the limits. Wiggins said removing the caps would save money and improve health.

"So I certainly hope there will not be a decision to not follow or implement the law that the Legislature passed, because it was the intent that that take place," Wiggins said. "If they are not willing to implement that at this time, what is the basis for that and why?"